Highlights
- •In patients with spontaneous subarachnoid hemorrhage treated with analgesics, headache duration can be very short
- •In neurologically intact patients with SAH, headache disappeared in ≈ 5% < 24 h after ictus and in ≈ 10% at 48 h
- •Earliest notification of absence of headache was 10 hours after ictus.
Abstract
Background
If acute severe headache disappears early after its onset, the question arises whether
subarachnoid hemorrhage (SAH) should still be ruled out. We studied the initial time-course
and minimal duration of headache in a consecutive series of neurologically intact
patients with spontaneous SAH.
Methods
We included patients admitted between 2012 and 2015 within 48 h after spontaneous SAH with a normal level of consciousness and no focal deficits.
We retrieved data on headache severity, measured with a Numeric Rating Scale (NRS),
<48 h after ictus. We analyzed the proportion of patients with a first NRS 0 and NRS <3 within 48 h after ictus and minimal headache duration. Patients were censored in case of a decrease
in level of consciousness, aneurysm treatment, or early discharge.
Results
We included 106 patients (62 aneurysmal SAH, 33 perimesencephalic hemorrhage, 11 other
spontaneous SAH). All patients were treated with analgesics. Within 48 h after ictus, a first NRS 0 was reported by 9 patients (8%;95%CI:3%–14%) and a first
NRS <3 by 22 patients (21%;95%CI:13%–28%). Shortest time lapse until NRS 0 was 10 h in a patient with aneurysmal SAH who had been on acetaminophen and tramadol since
2:35 h after ictus.
Conclusions
In a cohort of SAH patients with a normal level of consciousness and no focal deficits
who all used analgetics, headache disappeared in around 10% within 48 h after ictus. Our data indicate that a diagnostic work-up for SAH is also needed
in patients using analgesics in whom headache has disappeared after 10 h.
Keywords
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Article info
Publication history
Published online: May 24, 2017
Accepted:
May 23,
2017
Received in revised form:
April 24,
2017
Received:
November 2,
2016
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
